Healthcare Provider Details

I. General information

NPI: 1750776191
Provider Name (Legal Business Name): JAYE WATTS LICSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2015
Last Update Date: 09/09/2025
Certification Date: 09/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

186 PROVIDENCE ST
WEST WARWICK RI
02893-2508
US

IV. Provider business mailing address

186 PROVIDENCE ST
WEST WARWICK RI
02893-2508
US

V. Phone/Fax

Practice location:
  • Phone: 401-615-2800
  • Fax: 401-615-2805
Mailing address:
  • Phone: 401-615-2800
  • Fax: 401-615-2805

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberISW02666
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW01673
License Number StateRI
# 3
Primary TaxonomyN
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License NumberCBMT#06687
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: